I am therefore thanks to Doctor Lee Cheek Sang (Turning Point Integrated Wellness Sad Bad) and Low Mi Yen Turning Point Integrated Wellness Sad Bad) to give me some suggestion and guidance. I am deeply appreciating what my parents done for me. They are always giving me encouragement and warm for me until now. Furthermore, I must give thanks to several friends who continue to give strong moral support for me which are: Eng Is Lie, Tan Ye Ling, Eng Boon Young and Hong Shush Rang. To every one of you, I thank you.
This thesis has been completed by having all of your efforts and contributions. Approval Form This research paper attached hereto, entitled “A study of the prevalence of insomnia among University Dunk Abdul Raman”s Students” prepared ND submitted Bataan Shih Sheen in partial fulfillment of the requirements for the Bachelor of Social Science (Hon.) Psychology is hereby accepted. Supervisor Supervisor”s name Date: ABSTRACT Insomnia is common complaints in general population nowadays.
It caused by different factors such as physical (cardiovascular), behavior (daytime nap, early retirement to bed), environmental (quietness and brightness environment), and medication (alcohol, central nervous system stimulant). For adolescent, insomnia will affect their healthy and academic performance. In this study, it concentrated on here researches, which are the difference between gender difference towards insomnia, the relationship between insomnia towards stress and depression.
There are 100 undergraduate students in University Dunk Abdul Raman participated in this study. Besides that, three subspace questionnaires which are Insomnia Severity Index (IS’), Stress Perceived Scale (ASS-10) and Patient Health Questionnaire (PHS-9) used in this study. The research method that used is cross sectional design and the sampling method is convenient sampling. Through the findings, it found that there is no significance difference among gender towards insomnia. But it found that stress and depression is positive correlation with insomnia.
In conclusion, both genders have the equal opportunity to have insomnia. But in this study brought important information which is depression and stress is correlated with insomnia, so it can be a guideline for parent and educator to pay attention of the young generation. DECLARATION I declare that the material contained in this paper is the end result of my own work and that due acknowledgement has been given in the bibliography and references
According to Bud, Rodriguez, and Schaefer (2007), insomnia has been classified in few ways. For instance, it can be classified as cause (primary, secondary), symptoms (difficulty falling asleep, difficulty staying asleep, non- restorative sleep), or duration (acute = insomnia less than 1 month, chronic = insomnia for 1 month or longer). While all of the classifications are useful in the diagnosis of insomnia. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (as cited in Bud, Rodriguez, Schaefer, 2007), 0% to 49% of America adults have intermittent insomnia.
According to Medicine (201 1), Intermittent insomnia is an insomnia that occurs from time to time and each time lasts less than a week or two. An estimated of 10% to 20% of adults have chronic insomnia and approximately 25% of people with chronic insomnia have primary insomnia (Bud, Rodriguez, Schaefer, 2007). According to The Free Dictionary (201 1), chronic insomnia lasts more than three weeks and primary insomnia is a dysphasia characterized by persistent difficulty initiating or maintaining sleep or by persistently nonrestrictive sleep.
So, insomnia is prevalent among the adults in America (Bud, Rodriguez, Schaefer, 2007). According to Camel and Smack (2006), there are several causes of insomnia which are primary specific sleep disorders, physical illness, behavioral, environmental and medication. The examples for primary specific sleep disorder are Circadian Rhythm Disorders, Sleep Apneas and others. According to The Free Dictionary (201 1), Circadian rhythm disorder is a lack of synchrony between the schedule of sleeping and waking required by the external environment and that of a person”s own circadian rhythm.
While Sleep Apneas is define as a condition which an individual stop breathing for more than ten seconds during sleep. There are three types of sleep apneas which are Obstructive Sleep Apneas, Central Sleep Apneas and mixed sleep apneas. In Obstructive Sleep Apneas (OSHA), the breath will stop because tissue in the throat closes off the airway and Central Sleep Apneas (CSS) is the brain centers responsible for breathing fail to send messages to the breathing muscles. While mixed sleep apneas is the combination of the OSHA and CSS (The Free Dictionary, 2011).
Next, physical illness in body systems such as cardiovascular can lead to Insomnia. Besides several pains, menopause and psychiatric illness also play an important role in leading a person to insomnia. Furthermore, some behaviors such as daytime nap, early retirement to bed and else are creator of insomnia. The quietness and brightness of environment are the factor of insomnia. Lastly, the examples for medication that will cause insomnia are alcohol, central nervous system stimulant and others (Camel & Smack, 2006).
But according to the twin studies which conduct by Watson, Goldberg, Regardless and Buchwald (2006), insomnia is strongly influence by genetic factor. Furthermore, Audiogram (2006), stated that insomnia can bring negative consequence towards our activity in daily life. It will lead to ill health and predicted to have lower expectancy in life. Insomnia is associated with daytime impairment such as fatigue, irritability, decreased memory and concentration, also affecting many aspects of day time functioning.
Between, it is always co-related with affective disorders, substance abuse, and other physical and psychological commodities (Audiogram, 2006). As Legger, Guillemots, Bade, Livy, and Pillar (2002), stated that the social, insomnia is also associated with an increased risk of accidents According to Moron, Valises and Fivers (2007), Clinical and Research evidence that the sleep related cognition such as faulty beliefs, worry and attention bias play an important role in perpetuating and worsen insomnia. Problem Statement Insomnia is already bringing a lot of impact towards our life.
Unbar and Shallower (2006), have studied that sleep disturbances during adolescence can lead to inadequate parental supervision and environmental factors such as consumption of alcohol or caffeine (Gallantly, 2010). Moreover, adolescents also experience delay in he timing of sleep onset and awakening, associated with their pubertal status, which can cause a conflict with the social demands for early morning schooling (Unbar & Shallower, 2006). Specifically, insomnia affected up to 50% of patients with cancer (O”Donnelly, 2004).
Furthermore, Yang, Www, Whish, Lieu, and Lu in year 2003 stated that it may impact academic performance and health of a college student too ( as cited as Gallantly, 2010). So, the impact of insomnia is severity in this society nowadays. Operational definition Stress. U. S. Department of Health and Human Services Centers for Disease Control and Prevention (n. ) stated that stress is the influence that will disrupt one person well beings. It may bring effects on health as well as psychological change. However, sometime stress is beneficial Just if it is not overwhelm.
There are different types of stress which are positive stress, tolerable stress and toxic stress. Depression. According to Ebb & Ebb (2006), is defined as a type of affective disorder or mood disorder that characterized by pessimism, sense of inadequacy, decrease in daily activity and else that affect a person normal life. Moreover, if depression goes to certain extent, suicide can be resulted. There is 10% of American who affect by depression. World Health Organization had mentioned that depression will be the most common diseases on the earth by year 2020 (As cited in Ebb & Ebb, 2006).
Significance of study First of all, women are more likely than men to report insomnia symptoms (Bartlett, Paisley & Ideas, 2006). Buys (2004), stated that the rates of insomnia in women are typically 20 to 50% higher than in men. Besides that, women also reported more frequent with insomnia symptoms. Both women and men will have insomnia approximately once a month to several times a month on average (Hamilton et al, 2007). Epidemiological cross-sectional studies have shown the depression is connected to disturbed sleep (Г?crested, 2006).
According to Bartlett, Paisley and Ideas (2006), it has been estimated that 40 to 50% of individual with insomnia also experience depression. Meanwhile, Trek (2005), study shows depression and insomnia had been related by psychiatric. It has been estimated that more than 90% of patients that suffering from major depression also have sleep disturbances which can strongly linked depression with insomnia A study of Taylor and colleagues (as cited in Trek, 2005 ), were reaffirms the relationship of insomnia ND depression. The study found that people with insomnia were 9. 2 times more likely to have “clinically significant” depression than insomniacs, and increased insomnia frequency and increased number of awakenings were related to increased depression. Besides that, in a recent literature, psychosocial factor such as depression has been associated with insomnia severity (Blessing, Rutledge & Healy, 2010). The association between insomnia and stress is well known. Stress has been found to predate the onset of insomnia in 3 quarters of poor sleepers (Yea, Prefer, Kook & Twos, 1996). The relationship between psychological stress and insomnia is similar to pain and insomnia.
Sleep disturbances may increase cancer-related distress which lead to further sleep problems, contributing to vicious cycle in which insomnia lead to stress and stress lead to insomnia (Oddball, 2004). In conclusion, although there are different researchers proved that girls have the higher rate of insomnia compare to male while insomnia is correlated with both stress and depression, most of the samples are focus on western countries only. As we know, different countries have different culture, value, race, life-style and resonantly and so on and so forth.
It may lead to different result. For instance, research done by Ghana and Wing (2006) mentioned that there are no gender difference of insomnia in some Asian countries such as Japan and northern China. There are only few researchers done the research about the relationship between stress and depression towards insomnia in Asian especially the sample size is not just concentrate on undergraduates. So, it is important to conduct this study among undergraduates in Malaysia. Besides that, it also can find out that whether the result is same with western view.
For the future, it is not only can be a reference for educator and also parents and children. Research Questions The research questions are 1 . Does the male have higher insomnia rate as compare with female? 2. Does any correlated between stress and insomnia? 3. Does any correlated between depression and insomnia? Objective of study This study is conducted to examine whether gender difference in insomnia. Besides that, it also wants to find out whether stress and depression level have correlation with insomnia. The hypotheses of the study include: 1 .
Female is easier to have insomnia compare with male. . There is a relationship between stress and insomnia. 3. There is a relationship between depression and insomnia. CHAPTER II LITERATURE REVIEW cognitive and Physiological model of insomnia Insomnia is a disorder of hyperbolas experienced throughout the entire day. This hyperbolas may exhibit itself as a state of hyperventilate during the day and hard to initiate and maintain the sleep at night. This arousal can be explained by both cognitive and physiological models of insomnia (Roth, 2007).
According to The Free Dictionary (201 1), hyperventilate is abnormally increase arousal, responsiveness to tumuli, and scanning of the environment for treats. For the cognitive model of insomnia, it emphasizes that if individual worry and rumination about life stresses will lead to sleep problem and create the acute episodes of insomnia, especially in initiating sleep and returning back to sleep after an awakening. When the individual begins to experience sleep difficulties, worry and rumination translate from life events to worries about the sleep itself and about the consequences of not getting enough sleep.
This negatively-toned cognitive activity is further fueled if a sleep- elated threat is detected or a sleep deficit is perceived (Roth, 2007). According to Roth (2007), in parallel with the cognitive models, there is another model of the evolution of insomnia suggest that hyperbolas is primarily due to neurophysiology or physiologic factors. Physiological arousal has been evaluated through measurements of the whole body metabolic rate, heart rate variability, neuroscience measures, and functional nonrecurring.
The role of neuroscience systems is mediating some of effect of serotonin of the sleep and wake cycle (Cardinal & Panda-Perusal, 2006). Recent studies are make comparison between good sleepers with insomnia patients. For the metabolic rates, insomnia patients exhibited higher metabolic rates (measured at intervals across the 24-hour day) than the healthy controls. For the heart rate variability, it found that average heart rates were increased and variability was decreased in all stages of sleep in insomnia patients compared to healthy normal sleepers through 36 hour study (Roth, 2007).
According to Roth (2007), chronic activation of the stress response system in neuroscience systems proved the existence of sleeping arousal. Urinary technologies, Urinary free cortical levels and Cortical & direction tropic hormone (CATCH) make influence in sleeping condition. According to The Free Dictionary (201 1), catecholamine is a hormone to stimulate cellular activities and carry nerve impulses through the body while CATCH is a hormone that stimulate the secretion of cortisone and other hormone by the adrenal cortex.
Cortical is a hormone to regulate carbohydrate metabolism, immune system and maintain blood pressure. Urinary free cortical levels bring influence to poor sleeper and also correlated with total wake time of a sleeper. Besides, sleep percentage in the first stage and wake time after sleep onset are related to urinary catecholamine. Primary insomniacs have higher level of CATCH in their Plasma when compare to normal person especially in the evening. For these findings can prove that Hypothalamic- pituitary-adrenal axis (HAP) is linked with pathology of chronic insomnia (Roth, 2007).
HAP is a major part of neuroscience system and a mechanism to interact between glands, hormones and part of the mid-brain (The Free Dictionary, 2011). Finally, cerebral glucose metabolism is assessed by using positron emission tomography PET), an indirect measure of whole brain metabolism of insomnia patients. Insomnia patients exhibited greater cerebral glucose metabolism during waking and non-rapid eye movement (REAM) sleep states compare to healthy subjects. Moreover, research found that the insomnia patients metabolism rate have smaller reductions from waking to non-REAM sleep.
These findings suggest about the interacting neural networks involved in the inability to fall asleep, which include an emotion- regulating system, a general arousal system and a cognitive system (Roth, 2007). Gender differences. Some studies found that female reappearance in patients who sought treatment for insomnia but there is a study in year 2001 found that there was no significant different in gender. According to Mandrake (2001), there were 85 consecutive case were reported by Insomnia Clinic. 52. 9% male, 47. 15% female and the age range is 31-60 participate in this research.
The result showed that there was no significant gender difference in gender toward insomnia. But, other studies are proposed that female is more preponderance in insomnia. First of all, Ghana and Wing (2006), stated that there is a study to examine between the genders differences in insomnia. The study was used different meta- analyses to investigate the sex difference of insomnia among different conditions. 29 studies were included in this study. Maintenances were analyzed by using Comprehensive Meta Analysis (CAM). There are different analyses about gender in this study.
First, it was divided the studies into 2 groups which are 4 high quality studies which have met the criteria and 25 nationality studies which din”t met the criteria. The criteria include large studies (>4999 people), constructed/ structured diagnostic interviews, based on stringent operational criteria. Both of them showed a female preponderance in the risk of insomnia. Second, 29 studies were divided into 2 groups: 23 current insomnia studies (recent 1 week to 6 months) and 6 long-term insomnia studies (recent 1 year and lifetime). Both of them showed similar female preponderance in the risk of insomnia.
Third, it compared the sex difference in the prevalence of insomnia among elderly (2 65 years), middle-age (31-64 years), and young adult subjects (15-30 years). 3 groups showed female is in the risk of insomnia, but overall risk ratio progressively increased from 1. 28 in young adults to 1. 3 in elderly subjects. Another analysis is the studies of different regions. 29 studies were divided into 4 continents which are 11 studies in America, 11 studies in Europe, 5 studies in East Asia and 2 studies in Australia. Result showed that female excess in the risk of insomnia in all regions (Ghana & Wing, 2006).
Through this study of meta- analysis, it can be conclude that female is predisposition with insomnia. There is a study conducted by Johnson, Roth, Schultz and Burbles (2006), also reported that the difference between gender and insomnia. The data come from random sample of 014 adolescents who were 13 to 16 years old which are selected from households in a 400 member health maintenance organization encompassing metropolitan Detroit. Interviewers used computer-assisted structured interviews with each adolescent. Due to the analyses of insomnia and pubertal development, onset of menses was associated with a 2. 5-fold increased risk for insomnia. There was no difference in risk for insomnia among girls before menses onset relative to boys, but it was difference emerged after menses onset. In contrast, maturational development was not associated with insomnia in boys. Furthermore, analyses of insomnia symptom types reported that the association of insomnia with menses onset and the emergent gender difference may be attributable to difficulty maintaining sleep and nonrestrictive sleep symptoms of insomnia. In conclusion, gender difference in insomnia seems to emerge in association with onset of menses.
Besides that, according to Crystal (2004), insomnia is a disorder that can lead to substantial impairments in the quality of life and functional capacity. While this condition more frequently occurs in women than man. It is because insomnia is association with Ramona changes such as menopause or late-ululate phase of menstrual cycle that are unique to women. The relationship between hormone levels and sleep is complex, there appears an association between decrease in circulating estrogen and progesterone and an increased propensity to insomnia.
Another factor that is contributed to the high rate of insomnia among woman is that they are more likely to suffer from psychiatric disorders which are highly correlated with insomnia (Crystal, 2004). Stress and insomnia. A research regarding the relationship between stress and insomnia in Singapore have been conducted by Yea et al. 1996), in Singapore, there are no study of insomnia has been conducted in the general population. So, this study is a larger study on the prevalence of neurotic disorders in Chinese and Malay. One in three Chinese households and all Malay households have been selected as participants.
Indians and others religion were excluded as the expected number of affected individuals ware too low to make analysis. Yea et al. (1996), stated that the ages of participants are between 15 years old to 55 years old. Interviewers interviewed the same ethnic group by using an instrument comprising 3 parts which are anemographic data, part of Diagnostic Interview Schedule covering 6 disorders which are generalized anxiety disorder, panic disorder, obsessive compulsive disorder, phobic disorder, dysphasia, major depression and a section question with insomnia, level of stress and suicidal behavior.
It has been used Visual analogue scale (VASS) rating the level of stress participants perceived themselves to be suffering from and the sources of this stress. This was a measure of ongoing life stress as perceived participants and was not an independent measure of stress. 2380 individuals have en surveyed and 370 cases reported to have sleep problems. The result showed there are 75% of insomnia group has reported that their stress level was in the moderate to severe ranged, compare to 60% in the non-insomnia group. The insomnia group rate home stress is higher than work stress.
For the home stress, most of the insomnia patients are attribute their stress to their children, followed by their parents, spouses, siblings, in-law and others. In fact, home stress was the only source stress that was significantly higher in the insomnia group compare with non-insomnia group. The stress in the insomnia group was attributed to immediate family members. According to The Free Dictionary (201 1), immediate family members defined as a person”s spouse, child, child”s spouse, stepchild, stepchild”s spouse, grandchild, grandchild”s spouse, parent, stepparent, parenting-law or siblings.
In this study, there was a positive association between insomnia and increased stress level (Yea et al. , 1996). According to Г?crested (2006), stress involved increased psychological and physiological activation in response to demands and an activated HAP (hypothalamic-pituitary-directionally) system incompatible with aroma sleep. It has stated that the sleep impairment cause further increases in the HAP systems and promote a various cycle of stress and insomnia. Besides that, most insomniacs attribute their problem to cognitive arousal. ?resisted (2006), showed that increases in alpha and beta power and reduced delta power in economics with intrusive thoughts (stress-related). Disturbed sleep in itself may raise worried about being able to sleep the following night, which will contribute to the next night, a vicious circle thus being created. Disturbed sleep then become a stresses in itself. In inclusion, stress and insomnia is correlated with each other. Depression and insomnia. A study which has concluded that insomnia severity was significantly correlated with depression.